Superior Hypogastric Plexus Block

The superior hypogastric plexus is a collection of autonomic nerves that plays an important role in transmitting and modulating pain signals arising from the lower abdomen and pelvis. The ganglia can easily be blocked by inserting two long thin needles just above the sacral alae and directing them obliquely under the transverse processes of L5 eventually bringing the tips of the needles to lie just anterior to the lower portion of the L5 vertebral body or the L5-S1 disc. Properly done the insertion should be nearly painless. The plexus can be blocked with as little as 3-5 cc of a dilute solution of local anesthetic through each needle. Pain relief usually begins within minutes and may greatly outlast the pharmacologic action of the local anesthetic. Superior hypogastric blocks can be repeated with progressively greater and longer pain relief obtained. Neurolytic blocks are rarely done anymore, due to safer and more versatile techniques, such as spinal cord stimulation and intrathecal drug delivery systems.

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